Obama does support mandates. Why the big fuss?

Surprise, surprise: Barack Obama does support individual mandates for health care.

How?

First, Obama has proposed a mandate requiring that families provide health care insurance for their children.

Second, Obama has proposed charging back premiums as penalties for uninsured adults who come in contact with the medical system as a way of reducing the problem of free riders.

In other words, Obama favors mandates. The difference is whether the mandates are enforced retroactively or proactively.

So what's the big fuss about?

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First, a little more detail on Obama's proposals.

Here's what his Plan for a Health America says about mandates for children:

(4) MANDATORY COVERAGE OF CHILDREN. Obama will require that all children have health care coverage. Obama will expand the number of options for young adults to get coverage by allowing young people up to age 25 to continue coverage through their parents’ plans.

Although the plan itself does not specify an enforcement mechanism, Obama has publicly stated:

“I would sign them up in school in the same way they would get inoculated. I would fine parents if for some reason they refused. I am happy to be very clear on how we would enforce the mandate.”

As for adults, Obama has been a bit more...squishy. Here's what he said last week during the debate:

BLITZER: On this issue of mandates, those who don't, whether it's 10 million or 15 million, those who could afford it but don't wind up buying health insurance for one reason or another, they wind up getting sick, they go to an emergency room, all of us wind up paying for their health care. That's the biggest criticism that's been leveled at your plan.

OBAMA: If people are gaming the system, there are ways we can address that. By, for example, making them pay some of the back premiums for not having gotten it in the first place.

To be fair to Obama, he's not saying he would implement this policy immediately. However, he is making it clear that if people who can afford health care don't get it, he's going to propose they be charged back premiums when they touch the medical system.

That's a mandate, albeit one enforced in sub-optimal fashion.

What Obama is saying is that if people game the system (i.e., voluntary participation does not approach 100%), people who don't purchase health insurance but require medical care will be confronted with a choice: pay back premiums, or forgo medical care.

At the same time, if voluntary participation is close enough to 100%, then Obama sees no need to charge penalties. That's an important point, but it's also true that for all practical purposes, if voluntary participation levels were that high, the mandate features in both Edwards' and Hillary's plans would not be used either.

In other words, if voluntary participation is high, mandates won't be a notable feature of any of the plans.

If voluntary participation is low, all the plans have some form of a mandate.

The key difference is that Obama's proposed enforcement mechanism is retroactive, and the Edwards/Hillary enforcement mechanism is proactive.

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So Obama has conceded that mandates will play a role under his health care plan under the same conditions that mandates will play a role in the Edwards/Hillary plans.

The question is merely to what extent, and how they would be implemented.

So what's the big deal?

The big deal is that his attacks on the mandates in both John Edwards' and Hillary Clinton's health care plans will make it very difficult for him to enact legislation including the mandates which he has proposed.

Moreover, Obama's line of attack can be used against programs like Social Security and Medicare.

In other words, if you accept Obama's contention that the government should not mandate behavior, how can you argue for Social Security? How can you argue for Medicare?